Long-term effects impact on both physical and psychological health. Issues include fatigue, mobility problems, pain, breathlessness, malnutrition, depression and anxiety. There are also the late effects to contend with. Late effects are defined as physical or psychological health problems that present six months or later post treatment and could affect whole organ systems as a consequence of cancer treatments. Examples include cardiovascular toxicities, reduced bone density or hypothyroidism. There is a lack of evidence on how many people are affected by these lasting consequences of cancer, although Macmillan Cancer Support estimated in 2013 that approximately half a million people UK-wide had health issues post treatment. This number is expected to have risen sharply over the past decade.

In 2015, Macmillan Cancer Support interviewed people affected by cancer in a UK-wide study into their social and emotional care needs and found that 64 per cent of respondents had practical support needs and a further 78 per cent of respondents needed emotional support following diagnosis. Studies have proven the impact prehabilitation and rehabilitation can have on those living with cancer.

The concept of cancer rehab was developed in the United States during the 1960s, but the world has been slow to adopt it. A Danish study conducted in the early 2000s—the FOCARE research project—found that Danish cancer survivors experienced considerably reduced physical health, possibly as late physical effects of treatment. The problems reported by the cancer survivors suggest that cancer rehabilitation should include these aspects of living after cancer and take account of socioeconomic differences among cancer survivors. The study suggested that these challenges might be addressed optimally in multidimensional rehabilitation programmes.

Cancer rehabilitation involves a wide range of allied health professionals carrying out distinct roles throughout the pathway, such as dietitians, lymphoedema practitioners, occupational therapists, physiotherapists and speech and language therapists. They deliver specialist interventions that complement the skills of other multidisciplinary team members. Different patients will have different rehabilitation needs depending on the type, location and stage of their cancer. It is acknowledged that healthcare professionals, including support workers, may also contribute to the rehabilitation of people affected by cancer. Prehabilitation extends that care to before the treatment pathway.

Physical activity has been described as an underrated 'wonder drug' and more should be done to ensure people living with cancer are aware of its benefits. Macmillan’s Move More service was developed to help people with cancer become more active. Evaluation has shown it has the potential to support people with a range of long-term conditions and lead to behaviour change. This evidence and insight can now be used to ensure physical activity is seen as an integral part of cancer care. Being active before, during and after treatment is safe. It can reduce fatigue, reduce anxiety and depression, help you keep to a healthy weight, strengthen your muscles, improve bone health, improve your flexibility and ability to stretch, improve balance, and increase your confidence. This evidence has been put to great use in my constituency by Dr Rhidian Jones, who, in conjunction with the national exercise referral scheme, set up a prehabilitation programme for cancer patients in Cwm Taf. To quote Rhidian,

'We know that, when a patient is diagnosed with bowel or oesophageal cancer, it is an incredibly daunting time leading up to a major operation. Many of these patients are lacking in physical fitness and are extremely anxious in anticipation of their surgery; both of which can lead to poor outcomes after surgery. The aim of the programme is to improve patients' fitness, mental health and experience leading up to their surgery. As a result of these initial goals, we are seeing fewer postoperative complications and a trend towards shorter stays for our patients in hospital.'

Rhidian’s programme is having a dramatic impact on patients’ long-term chances. Coupled with an extensive cancer rehabilitation programme, we can ensure that patients in Wales do not just survive cancer, not just live with cancer, but live well with cancer. That has to be our priority. That is why I want to see programmes like Rhidian’s available to all cancer patients in Wales, and why we have to have extensive cancer rehabilitation programmes tailored to individual patient needs.

I do have to congratulate the Welsh Government. They have taken a positive stance on prehab and rehab services. In Wales, pre-treatment health optimisation and prehabilitation are explicitly mentioned in the cancer delivery plan for Wales 2016-20. This puts Wales ahead of other UK nations. I am informed by Macmillan that discussions are ongoing with Welsh Government about long-term sustainable prehabilitation delivery and funding. Macmillan have produced their primary care for cancer framework. This framework spans from initial consultation, referral and through to diagnosis and treatment and beyond. Pre-treatment health optimisation in primary care at the point of referral for cancer investigation is a key aspect of this framework.

I hope that the Welsh Government will adopt this framework when it launches their cancer services implementation plan, which is due imminently. However, whilst the quality statement for cancer states that prehabilitation and rehabilitation are key parts of the cancer pathway, this does not fill me with hope that services will be delivered on the ground. Despite commitments in the former cancer delivery plan to prehab and rehab services, the patient experience on the ground did not reflect the plans. Access to rehab has remained a postcode lottery with over a third of patients reporting that they received no post-treatment support at all.

A 2020 study, the 'Qualitative exploration of cancer rehabilitation in South Wales’, found that rehabilitation is not routine in the cancer pathway. Healthcare professionals reported numerous barriers to care provision. One of the main barriers is that cancer rehabilitation is not provided routinely within the cancer pathway. Given the importance of prehab and rehab services to cancer patients, I urge the Minister to commit this afternoon to ensuring that such services are available to and tailored to every single cancer patient in Wales. Thank you.